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Delaware Naloxone program learns lessons from supply chain problems

A 4-miligram Narcan-brand Naloxone nasal spray.
Paul Kiefer
Delaware Public Media
Delaware's Division of Substance Abuse and Mental Health switched to a larger, 4-miligram dose of Naloxone during the pandemic, but breakdowns in international supply chains impacted the Division's ability to acquire some components of the Naloxone kits it distributes to partners.

The opioid overdose reversing drug Naloxone is a core part of Delaware’s response to the overdose crisis, and state health officials are now trying to adapt to vulnerabilities in the drug's supply chain exposed during the pandemic.

As other agencies nationwide began ordering larger doses of naloxone over the past year — driven in part by concerns about the spread of fentanyl — Delaware continued to order kits with smaller doses, both because of cost savings and because health care providers reported larger doses weren’t medically necessary to reverse overdoses. As demand for the smaller doses dropped, so did production, making it difficult to keep a steady inventory of the life-saving drug.

The end of a patent on the larger dose of naloxone – sold under the brand Narcan – and the appearance of generic competitors last winter offered momentary relief as the price for larger doses fell, but a new challenge appeared: most Naloxone kit components are manufactured in China, and a breakdown in international shipping made it difficult to provide complete kits.

Division of Substance Abuse and Mental Health Director of Executive Programs Brent Waninger says while his team continued to provide naloxone kits when requested, they weren't able to place large orders for the drug, instead piecing together their supply bit-by-bit.

“Basically, we resorted to looking at inventory in the supplier database," he said. "There’s 300 kits available today? Buy all 300. There are 20 kits available tomorrow? Buy all 20 tomorrow.”

He says that while the supply chain problems have passed for now, the past year has pushed his team to stockpile Naloxone kits in preparation for another — possibly more severe — breakdown.

“Anticipating that there may be some additional supply chain shortages, we’ve started to look at projections farther out than we were," he said. "Now we’re looking at whether we have a four-month supply on hand in bags, face shields and meds.”

Meanwhile, the number of partners working with the Division to distribute naloxone – and the number of naloxone kits given to the public – continue to grow substantially.

Paul Kiefer comes to Delaware from Seattle, where he covered policing, prisons and public safety for the local news site PubliCola.